(English captions by Trisha Paul, University of Michigan.)

In this session, we are going to look at complex
emergencies, a major form of public health

disasters in the Eastern Africa region.

Let us start by looking at this scenario.

A certain district Y has been affected by
a 10 year conflict in which over 200,000 people

have been internally displaced and they live
in camps.

They cannot return to their homes for fear
of the rebels.

The living conditions and health status of
people in these camps is very poor.

This is an example of a complex emergency.

What then is a complex emergency?

A complex emergency is a deep social crisis
in which large numbers of people die from

war, displacement and hunger owing to man
made disasters.

This is a definition by Klugman.

It is also defined as a humanitarian crisis
with a breakdown in authority due to internal

or external conflicts that requires international
response. This definition is by the UN Office

for Coordination of Humanitarian Affairs,
OCHA.

Characteristics of a complex emergency include
violence and massive displacement of people and,

administrative, economic, and political collapse.

It is long lasting and widespread.

That means it affects a large number of people.

There is usually exploitation and worsening
of existing differences in civil society like

economic differences, social differences,
political differences, religious differences,

and others.

These often dispute over legitimacy of authority,
usually between government and other formal

or informal groups like rebels, insurgents,
etc.

Vulnerable population is at greatest risk.

Large scale humanitarian assistance is often
needed.

There is usually hindrance of assistance by
political or military forces, meaning that

some groups that have power may prevent others
from receiving assistance.

Complex emergencies are usually political.

They often result in catastrophic public health
problems.

Complex emergencies often include wars and
civil strife, armed aggression, insurgency

and other actions resulting in displaced persons
and refugees.

They usually have a political undertone.

Can you name some in your region?

Look at these pictures and try to understand
some of the effects of complex emergencies.

Priority interventions in refugee or mass
displacement of people situations.

There is need for Rapid Needs Assessment.

There is need to provide water and sanitation
for affected people.

There is need to provide food and nutrition
for affected people, need to provide shelter

and site planning, health care, control of
communicable diseases, and coordination of

the humanitarian response.

What is important in Rapid Needs Assessment?

Health priorities are identified on the basis
of rapid collection and analysis of data.

Information is collected on background of
displacement, risk factors, resources required

etc.

It is important to use a guideline based on
standards.

For instance, the SPHERE Standards.

Water and Sanitation.

Drinking water is top priority in complex
emergencies.

Both quality and quantity are important.

During first days 20 litres of water 
per person per day should be the target.

Poor and inadequate water supply is associated 
with sanitation related diseases.

Sanitation.

In the first days of the displacement, emergency
latrines for every 50-100 persons.

But these should be improved to 1 latrine
for 20 persons, and ideally 1 latrine per

family when the situation improves,
or the humanitarian situation

is addressed.

Food and Nutrition.

Population movement is both a cause and consequence
of food shortage.

Malnutrition is an important contributory
cause of death during complex emergencies.

Food distribution should be planned, effective
and equitable

Shelter and site planning is an important
aspect of complex emergencies, especially

when large numbers of people are displaced.

Shelter is important for protection, security
and privacy.

It is recommended that each person has 3.5 square
metres of available space for their personal use.

Appropriate shelter sites should be selected.

It should be in a secure location away from
border, availability of land and access to

water, and the location should be socially
and culturally agreeable to the affected persons.

Health care aims to reduce mortality
in the emergency phase of displacement.

Curative, preventive and rehabilitative care
is crucial.

Manuals and guidelines should be available
for standardization of treatment.

A Tier system of health care, that is hospital,
health centre and outreach services.

Determine human resource needs, recruit and
train health workers and place them where

they are needed.

Control of communicable diseases is very important
during complex emergencies.

Intervention strategies include attacking
the sources of infection like curative care,

isolation of highly infectious patients.

Prevent transmission of illness through environment 
sanitation, personal hygiene, and health education.

Protect the susceptible patients like measles
immunisation, chemoprophylaxis, and provision

of bed nets etc).

There is need for continuous surveillance
to detect epidemics and to assess the effectiveness

of interventions.

Coordination is another vital part of management
of complex emergencies.

The rationale is that there are usually many
actors involved in the response.

The goal is to achieve the greatest impact
through integration of activities, establish

clear leadership and co-ordination, ensure
priorities are shared between the intervening

partners, rationalise services by establishing
common standards, and ensure good communication

among stakeholders.